Why don’t journalists link to primary sources?

Ben Goldacre, The Guardian, Saturday 19 March 2011

Why don’t journalists link to primary sources? Whether it’s a press release, an academic journal article, a formal report, or perhaps (if everyone’s feeling brave) the full transcript of an interview, the primary source contains more information for interested readers, it shows your working, and it allows people to check whether what you wrote was true. Perhaps linking to primary sources would just be too embarrassing. Here are three short stories.

This week the Telegraph ran the headline “Wind farms blamed for stranding of whales”. “Offshore wind farms are one of the main reasons why whales strand themselves on beaches, according to scientists studying the problem”, it continued. Baroness Warsi even cited it as a fact on BBC Question Time this week, arguing against wind farms.

But anyone who read the open access academic paper in PLoS One, titled “Beaked Whales respond to simulated and actual navy sonar”, would see that the study looked at sonar, and didn’t mention wind farms at all. At our most generous, the Telegraph story was a spectacular and bizarre exaggeration of a brief contextual aside about general levels of manmade sound in the ocean by one author at the end of the press release (titled “Whales scared by sonars”). Now, I have higher expectations of academic institutions than media ones, but this release didn’t mention wind farms, certainly didn’t say they were “one of the main reasons why whales strand themselves on beaches”, and anyone reading the press release could see that the study was about naval sonar.

The Telegraph article was a distortion (now deleted, with a miserly correction), perhaps driven by their odder editorial lines on the environment, but my point is this: if we had a culture of linking to primary sources, if they were a click away, then any sensible journalist would have been be too embarrassed to see this article go online. Distortions like this are only possible, or plausible, or worth risking, in an environment where the reader is actively deprived of information.

Sometimes the examples are sillier. Professor Anna Ahn published a paper recently, showing that people with shorter heels have larger calves. For the Telegraph this became “Why stilletos are the secret to shapely legs”, for the Mail “Stilletos give women shapelier legs than flats”, for the Express “Stilletos tone up your legs”.

But anybody who read even the press release, which is a readable piece of popular science itself, would immediately see that this study had nothing whatsoever to do with shoes. It didn’t look at shoe heel height, it looked at anatomical heel length, the distance from the back of your ankle joint to the insertion of the Achilles tendon. The participants were all barefoot. It was just an interesting nerdy insight into how the human body is engineered: if you have a shorter lever at the back of your foot, you need a bigger muscle in your calf.

Once more, this story was a concoction by journalists, but more than that, no sane journalist could possibly have risked writing the story about stilletos, if they’d linked to the press release: they’d have looked like idiots, and fantasists, to anyone who bothered to click.

Lastly, on Wednesday, the Daily Mail ran with the scare headline “Swimming too often in chlorinated water ‘could increase risk of developing bladder cancer’, say scientists”. There’s little point in documenting the shortcomings of Daily Mail health stories any more, but suffice to say, while the story purported to describe a study in the journal Environmental Health, anyone who read the original paper, or even the press release, would see immediately that bladder cancer wasn’t measured, and the Mail’s story was a simple distortion.

Of course, this is a problem that generalises well beyond science. Over and again, you read comment pieces that purport to be responding to an earlier piece, but distort the earlier arguments, or miss out the most important ones: they count on it being inconvenient for you to check. It’s also an interesting difference between different forms of media: most bloggers have no institutional credibility, and so they must build it, by linking transparently, and allowing you to easily double check their work.

But more than anything, because linking sources is such an easy thing to do, and the motivations for avoiding links are so dubious, I’ve detected myself using a new rule of thumb: if you don’t link to primary sources, I just don’t trust you.

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How primary care will play a central role with health care reform

by Jeffrey L. Cohen

Healthcare reform used to imply just regulatory change. As time marches on, it also implies market change. Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed. Change is afoot!

If you follow my nahsaying on the issue, then you know I believe the expectations regarding ACOs are overblown and unrealistic. Martians will not land here en masse, although there may be an occasional stow away on a NASA craft. Put another way, as some others have said, ACOs are like unicorns—magical, mythical beasts that no one has ever seen. I don’t expect many to come prancing around in Florida, at least not South Florida, anytime soon.

Regardless of how you define it, and regardless of what the ACO regs (expected out by the end of March, 2011) say, one thing must be accepted: there is a strong movement in the public and private sector to (1) control and reduce healthcare costs, while (2) improving quality. And ANYTHING that can do that will have a strong spot on the chess board, whether you call it an “ACO,” and “Patient-centered medical home” or a “tomato.”

To be sure, the healthcare marketplace has been shaking and rattling for many years. The last time the industry shook anything like this was in the 90s, with the advent of such things as networks, IPAs, fully capitated care centers, PHOs and community healthcare purchasing alliances (CHPAs). As most know, there were two things missing from that evolutionary bump: (1) the requirement of quality metrics, and (2) tying compensation to those metrics. The healthcare reform law has both those features and they are likely to stick, even if the law vanishes under legal challenge.

A third and very important thing to notice about the 90s is that nearly all the integration activity (e.g. PPMs, networks, IPAs, hospital acquisitions) was in the area of specialty medical services, not primary care. Only the highest grossing medical specialties were sought after. And that hasn’t changed much! The integration activity today continues to be in specialty areas like orthopedics, OB/GYN, dermatology and the like. Even hospital integration activity involves specialty services to feed their hospital based services (e.g. cardiology)! What appears to be going on is simply this: stakeholders jockeying for the best defensive position. Integration appears to be largely designed to develop market share and contracting leverage. Primary care is largely being left out, and yet it is clear to most think tankers that it must take center stage in order to reduce costs and improve quality! Most of the market activity is based on short-sighted economic fears rather than a far-reaching commitment to the above mentioned core objectives. Simply put, it’s tantamount to putting one’s head directly in the sand.

So the question now, assuming that cost and quality will continue to be the leverage points, is how best to deliver care in a way that is extremely cost effective and which clearly demonstrates quality outcomes. And at least one important part of the answer seems obvious: primary care must take center stage. If we look behind the Wizard’s curtain in the regulatory and market changes in healthcare, what we would see is not some bald guy in a green suit. And it won’t be a hospital CEO who measures profitability by patient census. Nope. We’d see a primary care physician. While integration and growth can be a nice and important short term strategy, without primary care, the long term goal of cost reduction and quality enhancement is unlikely. In the future, only those healthcare businesses with a strong primary care component will be best situated to lead and flourish amidst the change policy makers and the business community seem committed to.

How? Any way you want! Regional primary care IPAs? Good. Large integrated primary care practices? Good. Specialist groups merging with primary care practices? Good. Hospitals employing primary care physicians? Good (for the hospital). Whereas the 90s really ushered in financial opportunity for a small group of entrepreneurial physicians, today’s tie in with quality indicators creates a huge opportunity for physicians to not only adapt, but also to thrive.

Jeffrey L. Cohen provides legal counsel for the Florida Medical Association, and can be reached at The Florida Healthcare Law Firm.

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Tagged as: Health reform, Primary care

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